Insomnia — trouble falling asleep, staying asleep, or waking too early, at least three nights a week — is more common in women than men at almost every age. The gap widens in midlife, when a large share of women report sleep problems.
The hormonal layer
Estrogen and progesterone both influence sleep. Progesterone has a mildly sedating effect; estrogen helps regulate body temperature and supports deeper sleep. As both fluctuate and fall in perimenopause, sleep becomes lighter and more easily broken.
Night sweats add a direct disruption: a sweat episode can wake you fully, and the cooling-off that follows can keep you awake.
The life layer
Midlife often brings a heavy mental load — caring for children and ageing parents, peak career demands — at exactly the moment sleep becomes more fragile. Anxiety and low mood, which also become more common during the transition, are among the strongest predictors of insomnia.
Why it tends to stick
Insomnia often starts with a trigger and then becomes self-sustaining. After weeks of poor nights, the bed becomes associated with frustration and alertness. People start going to bed earlier, lying awake longer, and watching the clock — habits that make the problem worse.
What actually works
- Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for chronic insomnia. It works for most people and the benefits last.
- Treating the triggers — night sweats, anxiety, sleep apnea, pain — removes what keeps restarting the cycle.
- Consistent wake times, even after a bad night, are one of the most powerful simple tools.
Sleeping pills can help short-term, but they don’t address the underlying pattern and carry side effects, especially with longer use.
If poor sleep has lasted more than three months and is affecting your days, it’s worth a conversation with a clinician — and specifically asking about CBT-I.